This application to the Global Network (GN) for Women's and Children's Research asks for the Global Network Research Unit of Aga Khan and Columbia Universities to be renewed for a third 5 year term. We believe that our track record, especially over the last 5 years, as documented in the full application, justifies an award for the next 5 years. The strengths of this application include a stable and highly productive team devoted to carrying out meaningful research to improve the health of women and children, large and varied populations for study, and an ongoing birth outcomes registry of 20 rural clusters of 500 deliveries per year each with excellent follow up. Pakistan, with a population of 180,000,000 people and some of the highest maternal, fetal and neonatal mortality rates anywhere in the world, provides every type of population that could be considered for GN studies. We have the largest number of rural clusters of any site in the GN with an active birth registry in each, and have also demonstrated access to a number of urban hospitals for deliveries and access to urban children for research purposes as well. To date we have recruited more than 220,000 subjects for GN studies. In the next 5 years, we plan to bring substantial external resources to the GN by building strong relationships between industry, foundations and the GN to do research meaningful to all three institutions. We will actively participate in the deliberations of the GN Steering Committee and continue to mentor more junior investigators at our site and other sites in the GN in research study design, and manuscript and grant preparation. One of our major goals is to improve facility performance in the care of mothers and infants. Our proposed common protocol alms to reduce facility fetal and neonatal mortality using a defined outcome related to facility care, e.g., the sum of intrapartum stillbirths and early (pre- discharg) neonatal deaths. Using a simple cellular telephone-based data collection system, rapid feedback on the defined outcome, and a quality assurance program aimed at reducing intrapartum related deaths; it is our hope to achieve a substantial improvement in facility-based pregnancy outcomes.